Screening, Eradication Curtail Post-Surgery Staph Infections

Studies demonstrate high prevalence of Staphylococcus aureus, effectiveness of screening

By Jeff Muise

HealthDay Reporter

FRIDAY, Aug. 13 (HealthDay News) -- Methicillin-sensitive Staphylococcus aureus (S. aureus) colonization is more prevalent among orthopedic surgeons than a high-risk patient group, but an institution-wide prescreening program for detecting and eradicating methicillin-sensitive and methicillin-resistant S. aureus among orthopedic surgery patients is feasible and can reduce surgical site infection rates, according to a pair of studies in the Aug. 4 issue of the Journal of Bone & Joint Surgery.

Ran Schwarzkopf, M.D., of New York University Hospital for Joint Diseases in New York City, and colleagues performed nasal swab cultures on 135 orthopedic attending surgeons and orthopedic surgery residents, and compared the results with nasal cultures of patients undergoing joint replacement and spine surgery. They found 1.5 percent of the physicians were positive for methicillin-resistant and 35.7 percent were positive for methicillin-sensitive S. aureus; this compared to a 2.17 percent prevalence of methicillin-resistant bacteria and an 18 percent prevalence of methicillin-sensitive bacteria in high-risk patients.

David H. Kim, M.D., of the New England Baptist Hospital in Boston, and colleagues instituted a prescreening program for S. aureus in individuals undergoing elective orthopedic surgery. The program involved nasal swab cultures followed by an eradication protocol of intranasal mupirocin and chlorhexidine showers for carriers. A total of 7,019 out of 7,338 patients underwent the preoperative screening (95.7 percent screening rate). During the study period, the surgical site infection rate was 0.19 percent, compared to 0.45 percent among 5,293 patients during a similar preprogram control period.

"Implementation of an institution-wide prescreening program for the identification and eradication of methicillin-resistant and methicillin-sensitive S. aureus carrier status among patients undergoing elective orthopedic surgery is feasible and can lead to significant reductions in postoperative rates of surgical site infection," Kim and colleagues conclude.

One or more of the authors of the second study disclosed financial ties to commercial entities.